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ALPINE TERRACE BLK 4 LT 3
Alpine T r'rclce Block 4 Lot 3 #015- 243 - 17 MUNICIPALITY OF ANCHORAGE DE, ITMENT OF HEALTH AND HUMAN SER~ Environmental Health Division ':' 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES -tILL '~,,~OI "c" s; L~.._Jc- FROM~---....~0 SEPTIC ABSORPTION Phone(s) No. INd. of ~.~oom~ WELL ~5~ ~7~ I ~ L0T LiNE LEGAL DESCRIPTION ~ I N ~ T~¢~ FOUNDATION Township, Range, Section ~ I~ ~ ~~) ~ ~ ~ ~ drIveway,As~BU~L~D~AGRAM(Sh~~~~cat~~n~~~e~~~s~pticsys~~m~pr~pertyhnes~~~un~at~~n~waterbodies,etc.) TANKS ~ SEPTIC ~ HOLDING Manuiacturer Capacity ~n gallons Material No. of Compadments TYPE OF SYSTEM // original grade ~ FT IS FT Fdl added above original grade Gravel depth beneath p~pe ~.' '~ Gravel length Gravel w~dlh FT Total absorpt,on area ~ SOFT Distance between iines FT " Installer Date Installed x( x/- /' WELLS ~ PRIVATE ~ OTHER (Identify) Classification (A,B.C) i Total Depth Cased to FT FT Installe~ Date Installed: REMARKS: Scale: Ill= ~ : .;' ENGINEER'S SEAL Inspections Pedormed by: I cedily that this inspeclion was pedormed according to ali 72-013 (3/85) ]. () /O!i]/fB 6 C:CtN'I'B'~C:T t" r. IC)NI:::, ~: L..i.:.!:i:')¢:'.:&.. D E: ~!i; [; I::;'. :1: F:' :: ~BIJii!ID I V I ~ :1: (:]l'q ~: ALP I NE TERRACE :LOT: ::~ ]: ,:::: e r' I:. :L f' y t:. h a ~:. ;2, :t: ~,~:i.].]. J.n~:La'.l.]. 'LI"~.) ~iy~i~.~}lm ~.l"l au::c:c~pdarn::~ ~t~'Ll"t a:l.~ :'L;, ~t: ~,~:i.].1 ~u::lt"l(.:.:.)r,~? 'L(::~ a?~].], PICI~ ~u"icl ~B'L~cL(.z.~ (::)f ~:l:l.~:~l.::~ r'r~,qL~.p~.)m~:,;~n'l:.~ 'F(::)r' CI"~(.:.:.) ~[~(~.:.:,'1:. bac:l.:: d:J.~vLL;:q-lc:(~,[~i fr'(::~m any exJ.~M:.:Lng ~,~:.~:L~ ~a~t.~,~t. ep clJ.~pc)~a.~ ~y~M:.r:,m or' pul:~].:i.c:: I000 ~ N~ I~ RN ~ IN,, I I F"r ~ e: ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE LEGAL DESCmPT~ON: ~O~, ~AL~/N~ T~ownship, Range, Section: SLOPE I 2 3 4 7 8 10 ,s GROUND WATER ENCOUNTERED? ~,~ 11 s L YES, AT WHAT O 12 TH? p E 13 to Water After g? I'~ I;::) Date: Reading Date Gross Net Depth to Net Time Time Water Drop 14 15 16 17 18 19 20 DEPTH ( I::: F ~:' , tx:' .."/,, . ", ~.~ IF -/~ ... DE ~ -L~ Deptr Moni PEI 3OLATION RATE /~,O Vl,~o,~ L. -- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~'//~ FTAND /.~ FT COMMENTS PERFORMED BY:, ~ ?~.~ '-' -'~~'/"' CERTIFY THAT/~THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ --~ /2~''~ 72-008 (Rev. 4/85) GAAB-HD- I ' ': , GPr~TER ANCHORAGE AREA BOROI~"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM PHONE LOCATION //-'~/~-'"/~"-~_~'~'_~----'-~'~ ,~t~--/4~--~-¢~ LEGAL DESCRIPTIO~.~z~. ,~--~.~,. SEPTIC TANK: DISTANCE FROM WELL --~'~ / LIQUID CAPACITY d~'~ ~---)c~ GALLONS. SEEPAGE SYSTEM: SEEPAGE PIT: MATERIAL ~/__p/'i~/~__~~ NUMBER OF COMPARTMENTS ~'? ~ -- ! ,' ,,~ / -'~/~r~r'/ LIQUID INSIDE LENGTH INSIDE WIDTH DEPTH__ NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE OUTSIDE DIAMETER --'"-" OR WIDTH /'-~ ~'~--~ ~ DISTANCE FROM WELL /-~/~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) LENGTH /dJ / ~ ! , DEPTH BUILDING FOUNDATION ~ '~' TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE NUMBER OF LINES ~E BETWEEN LINES ~ TRENCH WIDTH_ DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH OF LINES FECTIVE IN. ABOVE TILE WELL: TYPE~/~-d-~-~d'-~ DEPTH /'P/f///(/' DISTANCE FROM t~ WATER BUILDINg FOUNDATION./O SAMPLE ~ NEAREST SEPTIC ~ / SEEPAGE LOT LINE SEWER LINE ~ .,TANK SYSTEM dj , CESSPOOL NEAREST OTHER SOURCES DISTANCES: DIAGRAM OF SYSTEM HEALTH AUTHORITY CREATEI ANCHORAGE AREA )ROUGH CaseNo. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT APPLICATION TO INSTALL: SEPTIC TANK/~v , SEEPAGE PIT ,DRAIN FIELD ,OTHER TO SERVE THE FOLLOWING FACILITY PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS DISTANCES: , PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .. SEPTIC TANK SIZE TYPE SEEPAGE AREA DIAGRAM OF SYSTEM TYPE Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATU RE (~REATER ANCHORA .... AREA BOROUGF HEALTH DEPARTMENT 327 EAGLE STREET ANCHORAGE, ALASKA 9§§01 CASE Performed For , ~arc.~ieu .... Date Performed Legal Descrip~'i'on: LOt B~°Ck~S~divisi°n This Form Reports a: $o~l.s Log, Depth - - Soil Characteristics Location Sketch I Was Ground Water Encountemed? ~?_~. If Yes, A~ What Depth Reading Date Gross Time Net Time Depth To H20 Net 'e~°l'a~ib~"'J~ate' i~'/ hin'ht'e' '' ~ ' · Drop Proposed Install~a?iOh:'-~Seepage Pit Depth Of Inle~ ~ , Dep~ T6 Bot'tom O'~ ~it Or TPenc~---~ f ~/ A--'"- Drain Field Test Performed IAv3678970 • !t ?_ • ' Municipality of Anchorage a On-Site Water and Wastewater Program (907) 343-7904 SAFETY 3 ti Certificate of On-Site Systems Approval °` 6 8 c 9 Parcel I.D. 015-243-17 Expiration Date: I 1. GENERAL INFORMATION Complete legal description Alpine Terrance, Block 4, Lot 3 Location (site address) 11901 Circle Drive Anchorage, AK 99516 Current Property owner(s) Eric & Joy Knight Day phone Mailing address 11901 Circle Drive, Anchorage, AK 99516 Real Estate Agent Sherilynn Bare Day phone 907-230-9336 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: 1. Received by: I /il fide,07/ / N. Date: 7/(49/1g COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Sao,IYO Waiver Fee $ Date of Payment 113/it 8 Date of Payment • Receipt Number t 119 Receipt Number COSA# O SC I g 1;l) I-I' Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/02/18 • �pF At `SII� * 49 TH %\ *0�/ 6. DSD SIGNATURE rA Z %j }CJ System #1 Approved for bedrooms E.*. Michhael E.Anderson : 11 System #2 Approved for bedrooms � csTFq Z81- .• �/ Disapproved lkl ��"`\O. • Conditional approval for bedrooms, with the following stipulations: \sC'1 OF Ail,„ �jG ON-51 I E WATER AND Y¶1' tP WASTEWATER z" PROGRAM cg 0 4/.5-(s:0\l\C 'CO'—/ l? Original Certificate Date. 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E '• c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Alpine Terrace, Block 4, Lot 3 Parcel ID: 015-243-17 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N Date completed 1970 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth *74+ ft. Cased to 40+ ft. Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 9/11/86 6/07/18 Static water level 42 ft. 41 .6 ft Well production 0.75 g.p.m. 0.33 g.p.m. WATER SAMPLE RESULTS: 4 ES,s+iy Soo-C ttolobs$1, rock . Coliform 0 colonies/100 mL Nitrate 7.6 mg/L G Arsenic ND ug/L Date of sample: 5/31/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Date installed 6/2/1970 Tank size 1000 gal. Number of Compartments 1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) N Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 6/15/18 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed "'2586-527° Soil rating (g.p.d./ft2 or ft2/bdrm) 130/85SFBDRM System type Trench/Crib Length 26/13 ft. Width 3/10 ft. Gravel below pipe 5/6 ft. Total depth 10/10.5 ft. Eff. absorption area 260/276 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/07/18 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 476 gal. New depth 0 in. Elapsed Time: 1440 min. Final fluid depth 0 in Absorption rate >= 450 g p d None Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: On ad acent lots >100' Septic tank/lift station on lot **>50' j >100' On ad acent lots >100' Absorption field on lot 1 Public sewer main >75' Public sewer manhole/cleanout >100' > tank >75' Sewer/septic service line 25 Holding Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' >5� Absorption field >10' >10' >100' Water main Water service line Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: ***0, >10 >10' Property line Building foundation Water main Water Service line >10' Surface water >100' >10' Driveway, parking/vehicle storage None Noted 1 >100' Curtain drain Wells on adjacent lots F. COMMENTS *Depth taken from 1986 well inspection. **Well to tank distance legal at time of construction. ***Property line waver #WR010089 G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and �� F A i review of Municipal records that the above systems are in � L nkk conformance with MOA COSH guidelines in effect on this date. ���Q 1-•.'1-71# Engineer's Printed Name Michael E. Anderson, P.E. 0*; 49 TH /\ •,*(,J Date 7/02/18 ,A n . Michael E.Anderson .Q xil Oi A; ZFESSt`�+` COSA brown sheet_10-10-12.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Well Water Advisory Certificate of On-Site Systems Approval # OSC181314 Subdivision: Alpine Terrace, Block: 4, Lot: 3 This well's productivity was determined to be .33 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3-bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. • Mailing Address: P. 0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • '� 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181314 Subdivision: Alpine Terrace, Block: 4, Lot: 3 A water sample revealed a nitrate concentration of 7.6 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description Alpine Terrace Block/+, Lot 3 Location (site address) zxqoxCircle Drive COSA# Expiration Date: Current Property owner(s) Karen Stevens Mailing address Day phone Lending agency Mailing address Day phone Real Estate Agent Mailing Address Unlegs'~'t/~e'rwise requested, COSA will be held by DSD for pickup. 2~' NUMBER OF 'BEDROOMS: 3 Day phone TYPE OF. WATER"SuPPLY: Indi.viduai'V~ll. [~ Individual Water Storage [] Commt~hlity Class Well 'El TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ Individual Holding Tank. [] Community On-site r-~ Public Wa-t~"sy-ste m- ....... [] ........ Public ~e'wey The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services, LLC Phone 272-82z8 Address P.O. Box :~oo2z7, Anchorage, AK 995zo Engineer's Printed Name Steven R. Pannone, P.E. Date :~2/15/2OlO Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. Ail systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE jJ Approved for ;~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory ~ Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / c~ - /O,,. LOC - / 0 DiviSion- P,O. Aflch~r .~, ~ ~K: 995~1.~50 www:m .~Lorg/onsite (907)~ 343-7904 C~'FIF~E' ~.~"SI,~, SYSTEMS APPROVAL CHECKLIST Pamel :I.D: o1~.2.~-3.7 A. ,Vt~E~ ,DATA Wel~type ~r~ Date,.~,~/~.~ Date~of:test Static. Wa~er.~e~el .w. el~ ~ctiea ifA, B, or Cpmvide PWSI.D# 'Sanita~.se, a.~ (Y/N) Y Cased{o 6~ ff. PROM. WELL LOG g.p.m. B. :Nitra{e 7.~' mg/L Other bacteria ~Neg celonieS/1.00 mL Date of sample: ~i~/~e~.e Collectedb~.~ P~neer~_. Date installed:. NUmber of Co~,ents ~_ Cleaneets 'Depression over tank,(Y/N) N_ : , High,water alarm .~/N) N PUmper A, HomeSerwces S~,,: .~ting- (g~p.d;/ft2 or ft2/bdrm) ~ 4~-~' S~stem' Eft. ~ Men~ng&t~e Y ~~ever, f~Jd N ft, V~ater Absorption ~ >~/fSo+ ' :g~p;d. An~"C. ejuvenal~en trea~aent ~st tZ.mo:).(Y/N& type) fi,yes,, give date D= LIFT STATION Date k~staited "Pump on" level'at Datum in. E. SEPARATION DlSTA~tCES Size in gallons ~Pump oR level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septiotan~k/liff station onlot 78* Abso~tion field on lot ~eo+ Public sewer main 75+ Sewer/septicservice line 2~i+ Animal~containment areas ~o+ in. Manhole/Access (WN) High water alarm level at Meets,alarm & circuit requirements? On adjacent lots ~,oo. On, adjacent lots. ~.oo+ Public sewer manhole/cleanout Holding tank Manure/animal excrete storageareas ~.oo+ SEPARATION'OISTANCES FROM SEPTI'C/HOLDING TANK ON LOT TO: BUilding foundation 5+ ~ Property line ~o+ Watermain ~,o+ Water service line 2~+ Wells on adjacent lots SEPARATION: BIST~NCE FROM ABSORPTION FIELD ON 'LOT TO: Property li~e o** Building foundation, Water Sen/ice,'line ~+ ,Surface, water Curtain drain,, 50+ Wells on adjacent lots CO~ilMENTS * Distance was legal at.~he time of installation ** #WRoloo89. ENGII~E~.$ 'CERTIFICATION I ,certify ttmt l lmve dete~,ined through fietdJnspection$ and review of ~M*c~i~pal recerd$ ~ the above *$y~em$ are in c~nformance w~h MoA *'~SA!;~ide~$ in.effect on this date: Eng,in.ee~ Pri~ Name st~en,~ Pa~r~e,,P.E. Absorption field Surface water ~.oo+ Water. main 75+ Driveway, paridng/vehide storage ~.~+ W.~~e-r Fees, Date ,Of Payment Receipt Number COSA Fee $ ~ ~-: (~'," Date of Payment /-~-/~ "/ C~) (Rev. 11/05) in, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage, ak .us (907) 343-7904 Water Well Advisory Certificate of On-Site Systems Approval (COSA) # 101342 During a recent COSA on-site inspection and test of the potable water supply well on Block 4, Lot 3 of Alpine Terrace subdivision, the well's productivity was determined to be 0.45 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. ............ SGS ReL# 1106368001 Client Name Pannone Eng. Srv. Printed Date/Time 12/10/2010 9:57 Project Name/# Alpine Terrace B4,L3 Collected Date/Time 11/30/2010 16:30 Client Sample ID Alpine Terrace B4,L3 Received Date/Time 12/0t/2010 9:25 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/03/10 12/08/10 NRB Waters Department Total Nitrate/Nitrite-N 7.31 0.100 mg/L SM20 4500NO3-F B (<10) 12/02/10 AYC Microbiology Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 12/01/10 DLC Negative 1 100mL SM20 9223B A 12/01/10 DLC Aarow Pump & Well Service LLC (907)346-9355 Inspection Report 11901 Circle Drive Run camera to 42' in well. No perforations in casing found. Brian R. Wille Aarow Pump & Well Service LLC r- N O0°02'O0"E 4.1 .g3' ,00'Ogz'= I'q I~ 0 1 O' UTIL. ESMT. N O0°02'O0"W 210.00' Municipality of Anchorage Development Serv|ees Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. c,t~ -~¥,~ -I 7 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Expiration Date: Current Property owner(s) '7"¢,-,,-; Mailing address t t ~2 o t C', ,~ ~'~ D,'-; ,,,~ Lending agency ~n Day phone Day phone Mailing address Real Estate Agent /~,,,~_ F'$ GO Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: -~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of titIe (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A er B wells er a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and tTpe of structure indicated herein. ! further verify that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in cemplianca with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm ~1~t-/o~ '7'-~c/.,n,cc,/ ~rv;¢~ Phone Address Engineer's Printed Name '7-Aeo~-'e°"z' /::=. /'-~c,o,.~ Date 5. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. ,~ ... T.~C~.- ~ ~OO~= · .' · ~,~.. - C;-3589 ,' ~-~ bedrooms, with the following stipulations:-..~..-..~ Additional Comments Attachments: HAA Checklist Septic System Advisory Weft Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (so7) 3434s04 HEALTH AUTHORITY APPROVAL CHECKLIST LeoalDesct~ption: L~,~ ~: ~/oc~ q., /4-/?;~e "/'¢~'~¢~. A. WELL DATA Parcel ID: 0 r5'-?-¥3- 17 Wall type jar,,.'c~/~- Date completed 19 ?~-~ Total depth .~&¥ ff. If A, B, or C provide PVVSID # Sanita~j seal (Y/N) Cased to"> ¥~ ft. FROM WELL LOG Well Log {Y/N) Wires propedy protected (Y/N) Casing height (above ground) "~ AT INSPECTION Date of test Static water level ft* ft. Well production WATER SAMPLE RESULTS: g.p.m. g.p.m. Coliform G) colonies/lO0 mi. Date of sample: I O/' Y/O / Collected by: B. SEPTIC/HOLDING TANK DATA TankType/Material 5~ph(. ~/ ~_o~ Tank size 1000 gal. Number of Compadrnents Foundation deanout {y/N) )" ~* Depression over tank (Y/N) . Date of pumping ,~/?-.,~'/<:~/ Nitrate ~'t.,3 ~' mgJI. Other bacteria t--- I o [-/=,./, ')-ecl., ..Cc, c, __ colonies/lO0 mi. Date installed 0" / Z/.'70 Cteanouts {Y/N) ~' /V High water alarm (WN) AL,~ Pumper tR./,. I-Jo,,,~ S e~'o,e,~' Date instaited ~e"&. / 2. /'Yo, Soil rating (g.p.d./ft2 or ft2rodrm) 13o..~l,~,.,System tyPe~"'~' c'''r' ';'er'-/~'' ,P''''~ .,- ~.-~,.,., r ..~¢~ pipe ft. Length ~d" ft. Width 3" ft. Total depth ~ ft. Eft. absorption Monitoring tube Date of adequacy test Io /~)/o! Results (Pass/Fail) Gravel below O~~' Y' Depression over field tV For ~' bedrooms New depth O in. z'/5"~:? g.p.d. b<:~oco~ If yes, give date ,V. ~4. Fluid depth in absorption field before test ~ in. Water added I ?°~gal. Elapsed Time: lO '/min. Final fluid depth O in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) O. LIFT STATION Date installed 'Pump on" level at in. Datum E. SEPARA'[qON DISTANCES Size in gallons 'Pump off' level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: ~"~-eptlo ta~OJ~'~liff station on lot '7~''/~ c.c.,. ' Absorption field on lot I O H ' ~' ¢. o. Public sewer main /~' ~ sewer/septic se~ce line ~' Z$' Ma~hole/Ac~e~s (Y/N) High water alarm level at. Meets alarm & cimuit requirements? in. On adjacent lots On adjacent lots Public sewer manholeJdeanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '7 '~c.~,~,, C'.o. Property line Water main ~. ,4. ' Water service line ~, lC,' Wells on adjacent lots ~> Io~ ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ ~--~-' Water main Property line O' Water Service line ~>' (~' ' Curtain drain /~/o~¢ ~'~'~"'~ Absorpfion field ~ I ~ ' Surface water -;> (c/o, Surface water '~, /OO ' Driveway, partdngNehide storage ~ .¢'O ' Wetls on adjacent lots liP' F. COMMENTS '~ ~, bo~ I,,~, -, -,.,.' -- ~- - - Eng neer's Pdnt~ Name ~ , Date ~¢~ I~ HAA Fee $ ~*OC:? ~ Date of Payment Receipt Number //~,/-*/_~ ~-'2 ,"~' ' (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number OCT,-18-01 09:17 Fk~'-CT&E ENVII~:WkENTAL Cl'IE Environmental Services Inc. 96?5615301 T-953 P.OI/OZ F-484 Y1'&£ R~CJ 1017012001 Clleat PO# Pre-Paid ColL~'403 ~le.I N.me Fhttop Technical Srv. Printed D.te~l'lme 10/18/2001 8:41 eroJm Nlmd# L3,134 Alpine Ti.acc Collect.d Date/Time 10/09/2001 14:35 -"llent Sa mpte ID L3, B4 Alpine Tcrrace Receh, ed Date/'flme 10/09/2001 15:4~ ~.trJx Drinking V/ater Teehnl~l DtrKmr Stephen C, F.,de Ordered By Released B ' / ~' PWSID 0 Y Sample Remark: Nit~tc-N Allowable Pf~p A~ilysb R~ullx PQL I.~]a M~Tho~ LJm~ D~e Dec Init 4.36 0.$00 mB~, EPA 300.0 (<10) 10/09/01 SCL Tom] Col[fom~ 0 ¢ol/I00mL SMI8 9222B (<1) 10/og/0t RAP Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 .Water Well Advisory Health Authority Approval # 010550 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 4, Lot 3 of Alpine Terrace subdivision, the well's productivity was determined to be 0.49 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. October 16, 2001 MOA DSD P. O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means ofthis letter I am requesting issuance ora lot line waiver allowing the existing seepage pit serving the residence on Lot 3, Block 4, Alpine Terrace to be approved with a 0 foot separation from the north lot line common with Lot 4. A site plan is attached showing the spatial relation ofthe visible standpipes and a hypothetical configuration of the underground extent ofthe soil absorption system components. When the seepage pit was installed in 1970 the Borough inspector reported'that the separation distance from the pit to the nearest lot line was 20 feet. Subsequent HAA submittals also indicated that the minimum 10-foot separation distance was achieved. Field measurements made in conjunction with the recent adequacy test indicate that the seepage pit standpipe is approximately 7 feet from the lot line. On the enclosed site plan I have plotted a hypothetical configuration of the 10-foot by 13-foot log crib seepage pit. Because the exact configuration is unknown I am requesting the waiver be issued allowing a portion of the pit to be as close as 0 feet from the lot line. Granting the waiver will have virtually no impact on the ability to construct future septic upgrades on Lot 4. This is because the 100-foot protective radius surrounding the well on Lot 4 prevents utilization of that area for septic system installation. Please feel free to give me a call ifyou have any questions on this request. Sincerely, Ted Moore, P.E. WELL '-~ 100' LOT 4 BLOCK 4 1970 10' x 13' LOG CRIB -- SEEPAGE PIT 1970 1000-GALLON SEPTIC TANK 1988 '''''". 26-FOOT LONG SOIL ABS. TRENCf R 100' LOT 3, BLOCK 4 ALPINE TERRACE - WELL SEPTIC ~ " ............. SYSTEM STANDPIPES o LOT 2 BLOCK 4 ~ ."-~,,, .. ..~ LOT 3, BLOCK 4, ALPINE TERRACE S/D WELL AND SEPTIC SYSTEM SITE PLAN FLATTOP TECII~CAL SERVICES I INCH = 50 FEET 14530 ECIIO STREET DRAWN BY TFM ANCI IOPJ~GE, ALASY. A 99516 OCTOBER, 2001 NOTE: THIS IS NOTA SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. Municipality of Anchorage Development Services Department Building Safety Division On-Site Wnter mad Wnstewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchomgeJk.us (907) 343-7904 Waiver Review Worksheet WRY: WR010~I PID~: 01~-243.17 I-IA~: HA0t0550 Permit~: Date Received: 10118/01 Legal Description: Alolne Terrace Block 4 Lot 3 Engineer. Applicant: Terri Pauls Waiver Requested: 0 feet from field to lot IIn~ Criteria: Geology A. Water Table B. Soil Sorpfion C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver is Granted: Waiver Is not Granted: List Conditions or Reasons fix above: Date: By: Name of Reviewer Rec~: 11~,,4~ Amount: $115.00 Date Paid: 10118/2001 Municipality Anchorage George P. II uerch, Mayor Building Safety I)ivlston P.O. I~x 106Cfi0 · 4700 S. Bmgaw Strcct Anchorage, AlasM~ ~519-C~ * (~7) 3~3-~$01 http://aa~av.ci.anchomgc.ak.us 10/22/2001 Ted Moore Flattop Technical Services Subject: Waiver Request for Alpine Terrace Block 4 Lot 3 Waiver Request #WR010089 Parcel ID #015-243-I 7 HAA# 010550 Public Works Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to property line has been approved. The approved separation distance is 0.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. .~ If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On-Site Water & Wastewater Program DEpARTMi ...... ' , ~, Location (site address or directions) ; ; : ~ , ~:,' ~':Agent'L~ -,~* '. : ;. - .- ~ ~:,~ ~,Day phone." AddreSs ~ .r ~,;'. Unless, otherwise requested~ HAA,will be held for Public Water ~Ommuni*~ the State Individual Public sewer ! 088 * ID ,NYAA03 '.3 J.~aO~ "9 sluewwoo leUOlllPPV ,, JOJ le^oJdde leUO!l!puoo ......... ~.,'SLUOOJpeq . JoJ peAoJddv.. --'~ auniVNOlS SHHG "S Legal Description: A. WELL DATA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744 Health Authority Approval Checklist Well type Log present Total depth Sanitary seal Date of test Static water level Well production If A, B, or C. attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Casing height (above ground) Wires properly protected I~/N) AT INSPECTION ~o ' (,, ,4, O, '/o 7 WATER SAMPLE RESULTS: Coliform t9 Date of sample: ? O/ SEPTIC/HOLDING TANK DATA Date installed 6/)/70 Tanksize Nitrate 3, (o Other bacteria O JOo o Collected by: $ & $ ENGINEERING 17034 Eigle River Loop Road No. 204 E~lle River, AlaskI 99577 Number of Compartments I Cleanouts ~N) Foundation c[eanout (Y~ ~ o Depression (Yt~) /v 0 High water alarm (Y/I~) ~ o Date6~'Pu~aping 7/3t/qf- Pumper C. ABsoR~IO~ VmLO DATA Dateins~alled g/a3, 'g 03r/g6Soil rating (g.p.d./fi2 o&2~ ]~0 System~e Lengh 13 ~ ~6 Width ]o ~ ] Gravel thickness below pipe 6 ~Effective abso~fion area '~___9[ ~ &~ Monitoring Tube present(~).__Y* $ Depression over field (~ __Y ~ o ~ D~ Date~ of adequacy test ~lt / t /~ ~ Results~ail) ..... ~ Y~ For ~ bedrooms uid depth in abso~tion field before test (in.); O _ I~e~ately ~er~ ~gal. water added (in.): O ~ Fluid depth O (ins.) Minutes later: "A"":~" ',t ',~4:~r~on rate = ~ ~O ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) ,~o~,g t,.-mo~,,~ If yes, give date * T~7~O 74~~ct4 D. LIFT STATION Date installed Size iii gallons Manhole/Access (Y/N) "Pump High water alarm level at* .... *~.)atum ~'Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: olding tank on lot 3" 0 % · On adjacent lots / 0 O -/--. Absorption field on lot J 0 o ; On adjacent lots / o 0 ..,c Public sewer main 3J /A~ Public sewer manhole/cleanout ! Sewer/septic service line ~ ~ 4- Lift station SEPARATION DISTANCES FRO~OLDING TANK ON LOT TO: t /,,t Building foundation ~' ! ¢" Property line ~ 0 '/' Absorption field 5" Water main/service line ;I £ ~ Surface water/drainage /0~ t 9'- Wells on adjacent lots I oO 4-- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! ! Building foundation ~ o ~ Water main/service line ~2 5- -4- Surface water J 0 o: '~' Driveway, parking/vehicle storage area Curtain drain/o0,v~, tc ,~o~ n~ Wells on adjacent lots / O 0 F. ENG~ER'S CERTIFICATION I certi~ that I have determined thrufield inspections and review of Municipal records t~tems m conformance wi~h M~Af/M~uidelin~ in effect on this date. Signature Engineer's Name ~8~F C. ~O~d~ ['~~~,~, ,, Date , - -~ ~ -t -- ...................................................................................................... HAA Fee $ ~ ~ ~ ~ Waiver Fee $ ., Date of Payment .///~' ~-'"' ?~'~ Rev. 8/95 OSS: haalwk..doc Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Division .... '"L:.--- "-:~i ....... --: --- Laboratory Analysis Report w~T~R Client Sample ID L3 BLK4 A~,,PIN~ TERRACE client Name S & S ~NGINEERIN~ WOI~ Order 19381 Ordered By R, COWkN ~rinted Date 11/06/95 ~ 16:04 Project Name CO~lected Date 10/31/9~ ~ 15:45 Proj®ct~ Received Date ~1/02/95 ~ 10~20 PWSID UA Technical Director ST~EN C. EDE Sample Remarks~ SAMPLE COLLECTED BY: BOB C, OC Allowable EXt. Anal parameter Results Q~al Unite Meshod Limits Date Da~e Inlt Nitra~e-N 2.60 Il%g/I, EPA 3~3.2 3,0. 11/03/95 CMR * See Spe~,%al InstruCtions AboVe UA - Unavailable ** See Sample Remark~ Above NA - Not ~alyzed ~.{ ~ UndetecUed, Reported value is ~he practical q~anc,%fica~ion limic. LT - ~es Than GT ~ G~eacer Than D~- Secondary d~,lution, " 200 W, Potter Drive, An~b3rage, AK 99518.1606 -- T.I: (907) 562-2343 Fax: (907) 561-6301 c~,,,~=n~c~=~ Ca~ IT~F~ IN Al ARKA. CALIFORNIA. FLORIDA, IllINOIS. MARY~ND, MICHIGAN. MISSOURI. NEW JERSEY, OHIO. WEST ~0~ ~8'ON I~E[~69~06 ~ 9NIiSBI ~UID~BNWOD ~O:AI MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) : (b) Property owner ~~~ Mailing Address ~ (c) Lending Institution Mailing Address ~ Telephone ~J/.~ Business (d) Real Estate Company and Agent L/I~'I i'~ ~/~ ~--~ /'~/ Address ~'~.~i'C, (?' //~'~. //ey ~r~oJ[ Telephone _~ ~-~"~:J~' - ~ ~.~) ~ ~ -- (e) Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Familyr~i~ Number of bedrooms 3. WATER SUPPLY Individual Well~i~3/ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 '~JOM s,Jeeu!§ue leUO!SSe~oJd eql u! SUOlSSllllO JO sJOJJe JOj elq!suodseJ lou s! e08Joqou¥ jo XJ!led!o!un~ eqm 'penss! s! e~oU!lJeo e ejojeq ei~p eZXleUe Jo suoilo~dsu! 3onpuoo lou op SHHQ jo SeeXOIdLU~ 's3ueLueJ!nbeJ elels pue leJePeJ u!ei~eo ~jsBes ol JepJo u! suoBn3!lsu! 6u!puel J!eq1 pue SeLUOq JO sJeseqoJnd o~ ~selJnoo e se s!q~ seop SHHa eq£ 'e~S~lV jo e~elS eq~ u! pe~els!§eJ jeeu~§ue leUO!SSaloJd ~uepu~depu! ue Xq e^oqe ~ qdeJ§eJed u! ue^!§ suoBelueseJdeJ eq~ uodn XlUO peseq pei~oU!Jeo leAoJdd¥ ~1!Joq~n¥ q3leeH senss! (SHHQ) seo!^JeS U~LUnH pue q3leeH jo lueLu3JedeQ e§eJoqou¥ ~o Xl!led!o!un~ eq~ i~AoJdd¥ leUOB!puoo Jo SLU~ei leUOB!puoo pe^oJddes!Q ,, ~ peAoJdd¥ ~' Jo,~ pe^oJddv 'lVAOl:lddV SHHQ '9 lees s,Jeeu!6u~ el~(] ~UNI~F ANI~L~I~PALITY OF ANCHORAGE (MOA) ENViP, OI~~ERVICE$ DIHl~l~ll~ Authority Approval (HAA) ~.~'~'~/ ~ CHECKLIST- FEBRUARY 1984 FEI 2 1989 343-4744 A. WELL DATA Legal Description: RECEIVED Well Classification Well Log Pre e. nt (Y/N) /~J Date Completed (~J~ Total Depth'70 ~- Cased to l~u~,, Depth of Grouting /.~/n If A, B, C, D.E.C. Approved (Y/N) Yield O,, ~'~ ~j~ Static Water Level ,~ J ~ Casing Height Above Ground ~. ~ Electrical Wiring in Conduit (Y/N) Y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot (~('~ ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/A Pump Set At Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) i~ ; On Adjoining Lots ~-~/CC) J(;~ ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date To Nearest Sewer Service Line on Lot Water Sample Collected by .J,c-~E.? ,~'~:~' Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~,~,/7o Size /0(:30~ Standpipes (Y/N) ~/ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments / /~/ Foundation Cleanout (Y/N) Date Last Pumped '-~,~ ;for N/,~ Temporary Holding Tank Permit (Y/N) /~l /~'1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~(~ ~ ~ To Building Foundation To Property Line ~O ~ To Disposal Field To Water Main/Service Line z~O' '~ To Stream, Pond, Lake or Major Drainage Course Comments (~ P¢~ /'~4.0. i~, D /-'/~..C 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area ,,7__~(~¢ ~4 -'~ Depression over Field (Y/N) Results of Last Adequacy Test /3rD~'~U~ 'T~_.~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ~r,'/~ ~/ '-~f~c~ To Water Main/Service Line 1~'0 ~;~' .-f"/- /~-x~,~,, Type of System DeSign Length of Field .Z.,'~ ~ Depth of Field -~ /©~ Gravel Bed Thicknes§' i '.~;"! ! ' ''''' Statndpipes Present (Y/N) Date of Last Adequacy Test Z.//?/,,~-~ To Stream, Pond, Lake, or Major Drainage Course To Property Line ~' /0 ' To Existing or Abandoned System on To Driveway, Parking Area, or Vehicle Storage Area Comments-'~ '~ ~ '~-~.~-~ ~ To Cutback (if present) Date Installed X / ' ' Size in Gallons ~ "Pump On" Level at . 'X~ High Water Alarm Level at ~. Tested for ~l;erntSmeMnOtt Electrical C°des (Y/N) '~. Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Perm/~ed Bedroom?ating Against HAA Request** I certify thaYlJ~ave chec~rified, or conformed to ali MOA and HAA inspectio- ////'''/- ''~/~ guidelines in effect on the date of this Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. //~~,,~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 Date Report Printed: FEB 22 B9 @ 11:33 Client Sample ID:L3, B4, ALPINE TERRACE PWSID :UA Collected FEB 16 89 @ 10:00 bxs. Received FEB 16 89 @ 14:00 hrs. Preserved with :AS REQUIRED Client Name : CORWIN Q ASSOC Client Acct: CORWINP P.O.$ NONE REC'D Req $ Ordered By : JERRY KRESS Analysis Completed :FEB 17 89 Send Reports to: Laboratory Supervispr ,:STEPHEN C. EDE 1)CORWIN & ASSOC Released By : ~ ~. ~ 2) Special Instruct: Chemlab Ref 4:4274 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.28 mR/1 EPA 353.2 lO Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY 3.K. 1 Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected '* See Sample Remarks Above NA= Not Analyzed LT=ness Than, GT=Greater Than ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL, · ,.~-~\(:~'"~ - ~ ~-.~L-- ~.~ .~.--"~i .~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name Applicant Address Telephone: Home Business (c) Applicant is (check one): Lending Institution []; Owner/b'.:~cr I~; Buyer []; Other [] (explain); (d) Lending Institution Address '~, )'". ]~ (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other f:,'~, 75, - WATER SUPPLY Individual WellX Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank [] Note:/'f r,-,,if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDII~,., INSPECTIONS, TESTS, FILE SEARCH, D~*.., AND INFORMATION , As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this ins, p~ Name of Firm __+i)~4~g~~z ! ~ ..~ Telephone Address ~ /.~ ~ ~ .. ;_1.'---~.-,., · ,,w~-~ ~!0 v/ Date . /--- _-- ~ · - -- Engineer's Seal Appro'v~;d for · i }' bedrooms by ' '" 'Disapproved Approved ''.~ ~ "," Terms of Conditional ApPr~>ial ~ Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification Well Log Present (Y/.N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Descript on Z- J~ ,.~ ~-~/~'~ ~'~.4 ' ' - i '~ .i/) Cased to ~:~w~"~'*M Depth of Grouting 3C~~r .... '' Pump Set At ' '/ ~~.M ~ Sanitary Se~n Casing (Y/N) . Y~epression~und Wellhead (Y/N) DateCompleted N~4 _~,~,~ Yiel '-d~'7p'''6/3/1 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /~/,/,Z~ , Cleanout/Manhole Water Sample Collected by Water Sam pie Test Results Comments ,'// ','~J~); ; Adjoining Lots ;> On To Nearest Public Sewer / ,t'/~.~//~ To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed ~//~/~// Standpipes (Y/N) t//) //~/~/"~ No. of Compartments / Size /__ Air-'tight Caps (Y/N) -y Foundation Cleanou_~.~N_)_~/~:_ Date Last Pumpe~Od, Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation D!stances from Septic/Holdi~j_0~Tank: / To Water-Supply Well (. (:~3~.//~ ,.~ To Property Line To Water Main/Se~ice Line ~ Course I'1~/ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ,,,O~.~,~' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~-~//,,~O ~'4~,~ ~ Type of Date Installed ~ ~ ~ ~ ~ ~/~" Length of Field Width of Field ~ ~ ~ Depth of Field ~ ~ /~t~ Gravel Bed Thickness ~ ~ ~ ' - ~7~ ~ ~ ~ Square Feet of Absorption Area ~/ Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Results of Last Adequacy Test ~,~ ~ ~ /~~ Separation Distance from Absorption Field: / To Water-Supply Wel z/_/'~_,~ To Building Foundation '35 To Water Main/Service Line /~' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots -~-~/~ / To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Puma On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) / Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified,.er conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~~ Date MOA No. /oo/ 0oo Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal ~CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONEi (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOT 3, BLOCK 4, ALPINE TERRACE LOCATION: 11901 CIRCLE DRIVE OWNER: BILL SWAIN RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WELL: SEPTIC SYSTEM: PRIVATE, ON SITE FROM MUNICIPAL RECORDS: TANK: ESPINOSA CONCRETE, ONE COMP. ABSORPTION SYSTEM: LOG CRIB ABSORPTION AREA: 276 SQ. FT. SOIL RATING: 85 INSTALLATION DATE: JUNE 1970 1000 GAL. DATE OF PUMPING: NOT PUMPED DATE OF TEST: SEPTEMBER 11, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED'AND MEASURED. TANK WAS FOUND WITH 5 FEET OF COVER AND 52 INCHES OF LIQUID. CRIB WAS FOUND WITH A TOTAL DEPTH OF 8 FEET AND A LIQUID DEPTH OFF 42 INCHES. 200 GALLONS OF WATER WAS ADDED TO THE CRIB IN INCREMENTS OF 50 GALLONS THE RISE IN WATER LEVEL WAS NOTED EACH TIME. TOTAL RISE IN WATER LEVEL WAS 13.5 INCHES. INFILTRATION RATE WAS MONITORED FOR 5 HOURS. A TOTAL OF 64 GALLONS WAS ABSORBED DURING THIS PERIOD. TEST RESULT: THIS SYSTEM DOES NOT MEET THE CODE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. THE MEASURED ABSORPTION RATE IS 145 GALLONS PER 24 HOURS. ( ONE BEDROOM ) The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. ~:,.,.>. ,. ... ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) :279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 3, BLOCK 4, ALPINE TERRACE LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: 11901 CIRCLE DRIVE BILL SWAIN SINGLE FAMILY NO INSTALLATION REQUIREMENTS MET: YES PUMP YIELD: 5 GALLONS PER MINUTE DATE OF INSPECTION: SEPTEMBER 11, 1986 TEST PROCEDURE: THE WELL WAS PUMPED'FOR 25 MINUTES WHILE THE DRAW DOWN AND THE WATER FLOW WERE MONITORED. STATIC WATER LEVEL WAS FOUND AT 42 FEET BELOW TOP OF CASING. THE WATER FLOW WAS 5 GALLONS PER MINUTE UNTILL THE WELL RUN DRY. AT THAT TIME THE WATER LEVEL WAS 74 FEET BELOW TOP OF CASING. A TOTAL OF 125 GALLONS WERE DELIVERED. INCLUDED IN THIS FLOW WAS ALSO THE CONTENT OF THE STORAGE TANK, VOLUME OF WHICH IS UNKNOWN. THE WELL WAS ALLOWED TO RECHARGE FOR THIRTY MINUTES, DURING WHICH TIME THE POWER TO THE WELL WAS SHUT OFF. THE WELL RECOVERED 19 FEET, SHOWING A RECOVERY RATE OF . 95 GALLONS PER MINUTE. AFTER THE 30 MINUTES RECOVERY PERIOD THE WELL WAS DRAWN DOWN AGAIN. A TOTAL OFF 22.5 GALLONS WERE DELIVERED,GIVING A WELL YIELD OF .75 GALLONS PER MINUTE. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON SEPTEMBER 12, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received February 19, 1976 Time of Inspection ~.'~ Date of Inspection ~-~/~- Phone: 344-6242 .~A~¥roval requested by: James W. Starkey Mailing Address: Box 392B Star Route A 2. Property Owner: Same as above. Phone: Mailing Address: Legal Description: LOt ~ Block ~\ Alpine Terrace Subdivision Location: O'Malley Road Type of facility to be inspected Single Family No. of bedrooms Well Data: A. Type Individual C. Construction~ Sewage Disposal em: A. Installed C. S~P%ic Tank: 1. Size D. seepage Pit: B. Depth D. Bacterial Analysis B. Installer 2. Manufacturer 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re~ st for Approval of Individual .~ ~.r & Water Facilities Lot &~ Block ~ Alpine Terrace Subdivision Legal Description Comments , Appr~ ~Valid for one year from date signed Greater Anchora~Ke~Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM Certify that the information contained in this request for approval to be a true and accurate representation~of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED / EQ-034 (1/74)